Sapna Palep, MD on Providing Personalized Care and Outcomes

March 2020 $5.00 Volume 16, Number 2 medestheticsmagazine.com INVESTIGATING YOUR COMPETITION

Additional Degrees That Improve Patient Care Sapna Palep, MD On Providing Personalized Care and Outcomes

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TOOLS AND TECHNIQUES 28 Light Therapy by Inga Hansen Top indications for LED treatments in aesthetics 42 Blemish Control Products addressing acne and pigmentation concerns 44 Collagen Builders Antiaging skin care for patients 54 Redness Relief Rosacea, anti-redness and postprocedure products 56 Aesthetic Technologies 46 Aesthetic devices for your practice COVER: Sapna Palep, MD PHOTOGRAPHY: Kevin Brusie 64 Newsmakers by Inga Hansen Canfi eld Scientifi c’s HairMetrix PRACTICE MANAGEMENT 36 20 Business Consult by Cheryl Whitman Shopping the competition 24 Legal Issues by Alex R. Thiersch, JD Needle-free injectors 20 36 Dual Degrees by Stephanie Kramer How MBA and MPH degrees can benefi t your medical career 46 The Minimalist by Echo Montgomery Garrett Sapna Palep, MD, and Spring Street Dermatology IN EVERY ISSUE 12 Best Practices 16 Introductions 58 News & Events 62 Advertiser Index

MedEsthetics (ISSN 1937-2140 & USPS 024-336), Volume 16, No.2, March 2020 is published monthly except in February, June, August and December by Creative Age Communications, Inc., 7628 Densmore Ave., Van Nuys, CA 91406- 2042, USA, Phone 818.782.7328, Fax 818.782.7450. Basic annual subscription rates are: $48.00 in the U.S., $65.00 in Canada, and $70.00 in other international countries. Periodicals Postage Paid at Van Nuys, CA and additional mailing ofﬁ ces. POSTMASTER: Send all UAA to CFS; NON-POSTAL AND MILITARY FACILITIES: send address corrections to MedEsthetics, P.O. Box 460159, Escondido, CA 92046-0159.

EDITOR'S NOTE EDITORIAL ADVISORY BOARD

Mary Lee Amerian, MD Medical Director, Santa Monica Laser and Skin Care Center, LEADING AND Santa Monica, CA Bruce Katz, MD Director, Juva Skin & Laser Center, LEARNING Clinical Professor of Dermatology, Mount Sinai School of Medicine, As we were preparing this issue, I had the opportunity to attend New York City the Medical Spa Show in Las Vegas. Soon, I will be heading out to Denver for the American Academy of Dermatology meeting. Joel L. Cohen, MD Inga Hansen Industry conferences provide a wonderful opportunity to Director, AboutSkin Dermatology Executive Editor/ network, learn and gain inspiration. and DermSurgery, CO Associate Publisher Associate Clinical Professor of Dermatology, During the Medical Spa Show’s Mini-MBA track, business University of California - Irvine coach Wendy Collier spoke on leadership and shared her fi ve-step COACH strategy to becoming a better leader: Michael H. Gold, MD Founder, Gold Skin Center, C – See your people as Capable. You must have faith in your staff and they will have Assistant Clinical Professor, Vanderbilt faith in you as a leader. University Medical Center O – Be Observant. Step back and observe the verbal and nonverbal cues occurring Nashville, TN among your team members. This helps you understand what’s going on in your practice and catch potential problems before they blow up. Mitchel P. Goldman, MD A – Be self-Aware. Leaders must understand the impact they have on their staff. Your Medical Director, West Dermatology, Volunteer words and action affect your employees’ attitudes. Clinical Professor of Dermatology, University of C – Be Curious. Don’t just hand down directives, ask questions. By asking employees California - San Diego for their input when problems arise, you can build a solutions-focused vs. problem- focused team. Jeannette Graf, MD H - Hold staff members accountable. Accountability empowers employees. Assistant Clinical Professor of Dermatology, Mount Sinai Medical Center, Running a practice is not easy, but the freedom it afford physicians in choosing their New York, NY own team members, setting their own treatment protocols and establishing their own culture of care can be well worth the extra hours and demands of business ownership. Lorrie Klein, MD Some physicians have found that obtaining a Master’s of Business Administration (MBA) Founder, OC Dermatology degree gives them an advantage in managing their businesses, but is this path necessary & Euro Day Spa, Assistant Clinical Professor of Dermatology, and right for everyone eyeing private practice? On page 36 (“Dual Degrees"), physicians University of California - Irvine discuss which additional advanced degrees offer the most benefi t for aesthetic physicians. If you are looking for ways to stand out in a crowded market or thinking of launching a new practice or medspa, performing a competitive analysis can help you pinpoint your Hema Sundaram, MD Director, Sundaram Dermatology, Cosmetic & unique attributes and target patient base. It can also help you identify your practice’s Laser Surgery Center strengths and weaknesses. Our Business Consult column (page 20) offers an overview of Rockville, MD how to shop your competitors’ practices and perform a competitive analysis based on the data collected. Alex R. Thiersch, JD On page 60, you will fi nd a full list of upcoming industry events and conferences. We Founder and Director, American Med Spa hope to see many of you there! Association (AmSpa), Partner, ByrdAdatto Law Firm Chicago

Wm. Philip Werschler, MD Director, Spokane Dermatology Clinic and Werschler Aesthetics, [email protected] • 603.354.3291 Spokane, WA

10 MARCH 2020 | MedEsthetics

BEST PRACTICES

SAFER CHIN Nutrition INJECTIONS In an effort to improve the safety of chin and Skin injections, Tanvaa Tansatit, MD, MSc, et al, performed cadaveric dissections to determine Health the locations of the ascending mental arteries. Aesthetic physicians can help After dissecting 31 embalmed cadaveric faces, patients achieve long-term the researchers found 19 dominant ascending skin health and slow the signs mental arteries on the right side of the inferior of skin aging by providing margin of the mandibular protuberance nutritional counseling and 12 on the left. The dominant ascending alongside their in-offi ce treatments. In “The Role of Medical Nutrition mental arteries enter the chin paracentrally, Therapy in Dermatology and Skin Aesthetics: A Review” (Journal of Drugs approximately 6mm (5.64 ± 4.34mm) from the in Dermatology, January 2020), authors Martina M. Cartwright, PhD, RD, et midline, within the muscular plane, and at a al, provide an evidence-based overview of nutritional recommendations for depth of 4.15 ± 1.95mm from the skin. The main various cutaneous concerns. artery forms an anastomosis with the sublingual They found that in large-scale studies, middle-aged women with wrinkled artery, within the fl oor of the mouth. skin consumed less dietary protein, potassium, vitamin C and vitamin A. In the paper, published in Plastic and Lower linoleic acid and vitamin C intake was associated with drier skin. Reconstructive Surgery (January 2020), the Subjects whose diets included eggs, yogurt, legumes, fruits, vegetables authors note that arterial occlusion of the and olive oil had less wrinkling on sun-exposed skin. Consumption of mental artery can result in soft-tissue infarction. vitamin C and lycopene-rich foods also led to smoother skin with less visible Therefore, “every aesthetic physician should sun damage. recognize the course of the ascending mental Overall, a Mediterranean diet, which is rich in fruits, vegetables, whole artery and use the appropriate techniques to grains, beans, nuts, seeds, legumes, red wine, fi sh and olive oil, helps to reduce avoid vascular injury during chin augmentation infl ammation. The authors noted that this diet can be benefi cial for patients with using fi ller injections.” infl ammatory skin conditions and may also help improve skin tone and texture.

Thulium Laser for with the TL (20mJ/mb, 500mJ/cm2). Photodamage Follow-up at 12 weeks included clinical assessment of overall photodamage, on the Décolleté mottled pigmentation and rhytides, A side-by-side randomized controlled using optical coherence tomography trial by Kristoffer Hendel, MD, et al, (OCT) imaging. revealed that treatment with a 1,927nm The areas treated with TL and Thulium laser (TL) is as effective at combination TL-PDT showed equal reducing photodamage on the décolleté improvement in overall photodamage, as combination treatment with TL and mottled pigmentation and rhytides photodynamic therapy (PDT). compared with lesion-directed control. The study included 12 women with Areas treated with combination TL-PDT moderate-to-severe photodamage on the showed greater improvement in skin décolleté and a cumulative total of 184 texture compared to TL alone. Complete thin grade I AKs. All AKs were treated median AK responses were similar for with lesion-directed curettage. Subjects’ all interventions and control. No scarring décolletés were then divided into four or adverse events were observed, but treatment areas and randomized to skin response following treatment was receive one single treatment with TL, PDT, more pronounced in areas that received combination TL and PDT or only lesion- combined TL-PDT. directed curettage (control). The study was published in Lasers in

Six patients underwent eight passes Surgery and Medicine (January 2020). WILDPIXEL/ISTOCK; VLADIMIRFLOYD ISTOCK

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Visit us at: • AmSpa Boot Camp • Phoenix, AZ • April 4-5 • SkinCare 2020 • Mandalay Bay Resort & Casino Las Vegas, NV • April 22 - 26 • The Aesthetic Meeting 2020 • Mandalay Bay Resort & Casino • Las Vegas, NV • April 25 - 27 BEST PRACTICES

Zinc Promising Protocol Supplementation for Removal of Eyebrow Tattoos for Acne Skin of color patients who would like A literature review performed to remove their brow tattoos may by Raja Sivamani, MD, et have a new treatment available. A al, and published online in pilot study by Farah Moustafa, MD, the American Journal of Clinical et al, showed that treatment with a Patient outcomes were: 75 percent Dermatology (November 19, 2019) dual-wavelength (1,064nm/532nm) clearance in patient 1 after three treatments revealed strong evidence for the picosecond laser combined with a over a period of 2.5 months, 75 percent use of zinc supplementation to Perfl uorodecalin (PFD)-infused patch clearance in patient 2 after one treatment, combat the infl ammation of acne is both safe and effective. 90 percent clearance in patient 3 after one and atopic dermatitis. The physicians treated four patients treatment and 100 percent clearance in The researchers searched with skin types III–IV with a dual- patient 4 after one treatment. All patients the Cochrane Central Register wavelength picosecond Nd:YAG laser experienced mild and transient localized of Controlled Trials, EMBASE, using the 1,064nm wavelength with a erythema and edema immediately MEDLINE and Ovid for all 3mm spot size and fl uence of 4–4.6J/ following each laser treatment as well as papers on the use of zinc for cm2. One patient (Patient 2) also received some epidermal crusting for three to fi ve infl ammatory dermatologic treatment with the 532nm wavelength days following treatment. Eyebrow hair conditions (including acne (4mm spot size and fl uence of 0.5J/ growth was not affected and no serious or vulgaris, atopic dermatitis, cm2). Three patients underwent a single unexpected adverse events were reported. diaper dermatitis, hidradenitis treatment session. One patient (Patient The study was published in Lasers in suppurativa, psoriasis and 1) had a total of three treatments spaced Surgery and Medicine (online December rosacea) up to May 29, 2019. six to eight weeks apart. 11, 2019).

LASER SAFETY PROTOCOLS DO NOT IMPEDE OFFICE EFFICIENCY Failure to follow standardized laser safety protocols often stems from concerns that strict adherence reduces clinical effi ciency. In an effort to combat these concerns, Ronda S. Farah, MD, and Adarsh Ravishankar, MS, published the outcomes of an improvement project at the University of Minnesota Cosmetic Center’s laser program. The project included multiple interventions in the areas of laser maintenance protocols, improved laser safety They identifi ed 229 articles, measures and better training for staff, residents and students. By performing staff audits and 22 of which met inclusion criteria. tracking patient time in clinic, the authors demonstrated that these interventions led to an Ten of 14 studies evaluating the overall compliance rate of 98 percent, with no signifi cant changes to clinic effi ciency. effect of zinc supplementation on Three categories of interventions were designed and implemented, including laser acne found the supplementation maintenance, clinical laser safety and training. Over the course of four months audits were to be benefi cial. Zinc was also performed to track compliance—measured as a percentage of protocol steps completed— shown to be benefi cial in one of as well as patient treatment times. All 31 audits revealed compliance rates greater than 98 two studies on atopic dermatitis, percent. The average patient treatment time post-implementation was 13.8 ± 7.8 minutes one of one study on diaper compared to pre-implementation times of 14.5 ± 10.8 minutes. dermatitis and three of three “We hope these fi ndings will infl uence clinicians to implement strict laser safety protocols, studies evaluating its effects and to allay concerns that such interventions will affect clinical effi ciency,” said Dr. Farah, who on hidradenitis suppurativa. is an assistant professor in the department of dermatology at the University of Minnesota, The one article found on director of medical dermatology at the University of Minnesota Health Maple Grove Clinics, psoriasis and one article found and the founder and lead of the University of Minnesota Health Cosmetic Center. on rosacea showed no signifi cant “Implementing Laser Safety Standards in the Outpatient Academic Dermatology Clinic: benefi t of zinc supplements on A Quality Improvement Based Study,” was published in the December 2019 issue of Lasers

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INTRODUCTIONS

1 POST-INJECTION HEALING SUPPORT Alastin Skincare INhance Post-Injection Serum with TriHex Technology minimizes side effects, such as bruising and swelling, following treatment with injectable dermal ﬁ llers. The serum includes ChromaFADE Technology, a blend of peptides and active ingredients that reduce bruising by accelerating the body's natural removal process of excess iron, and TriHex Technology, which helps clear out 1 damaged elastin and collagen and support the skin’s natural ability to produce new elastin and collagen. The cooling applicator tip helps soothe sensitive skin during application. Contact: 844.858.7546, alastin.com. 2 SMOOTH AND TIGHTEN A combination of growth factors and proprietary peptides work together to smooth, tighten and hydrate skin in NEOCUTIS 2 BIO-SERUM FIRM. Human growth factors and peptides boost production of collagen and hyaluronic acid in the skin while sodium hyaluronate seals in moisture and increases skin elasticity. Additional ingredients include antioxidant arginine, skin-tightening Pullulan and exfoliating acetyl glucosamine. Contact: 866.636.2884, neocutis.com. 3 TINTED SUN PROTECTION ISDIN’s Eryfotona Ageless Ultralight Tinted Emulsion SPF 50 is a 100 percent mineral sunscreen that contains a blend of peptide Q10, peptide complex, DNA Repairsomes and antioxidants. The formulation enhances skin repair by ﬁ ghting free radicals and 3 stimulating the body’s synthesis of coenzyme Q10 (CoQ10) while protecting skin against UV rays. The universal tint helps hide skin blemishes while providing a more even complexion for all skin types. Contact: 862.242.8129, isdin.com. 4 FRACTIONAL PLASMA RESURFACING Alma Lasers Opus Plasma addresses global and localized skin texture and quality with fractional plasma technology. Operating 4 at a frequency of more than 40MHz, the metal pins on the Opus Plasma tips are charged with high radiofrequency (RF) voltage. When in close proximity of the skin, the RF-charged pins react to atmospheric pressure in the air, creating plasma that, in turn, creates microthermal zones of fractional injuries. The plasma intensity can be adjusted based on the desired ablation effect to deliver light, moderate or aggressive resurfacing treatments. “Fractional plasma will change how we think about resurfacing.

If full-ﬁ eld CO2 technology was resurfacing 1.0, and fractional technology was resurfacing 2.0, fractional plasma technology is resurfacing 3.0,” said Jeffrey Hsu, MD, FAAD, a board-certiﬁ ed dermatologist at Oak Dermatology in the greater Chicago area.

“I can produce results to match the most aggressive CO2 laser or the gentlest laser peel in a fraction of the procedure time with less patient downtime.” Contact: 866.414.2562, almalasers.com.

16 MARCH 2020 | MedEsthetics

INTRODUCTIONS

5 PROFESSIONAL PEELING The Medicalia Professional L+ Lactic Peel can be used to reduce 5 acne blemishes, lighten areas of hyperpigmentation, minimize ﬁ ne lines and wrinkles and brighten the complexion. L+ lactic acid exfoliates by dissolving dead epidermal cells, counteracts dehydration and helps regulate the skin’s pH balance. It also possesses antiseptic properties and serves as a skin-lightening agent by suppressing the formation of tyrosinase. The peel is safe for all skin types. Contact: 866.314.1975, medicalia.com.

6 FACE, BODY AND MUSCLE The InMode Evolve noninvasive hands-free workstation delivers 6 bipolar radiofrequency and electromagnetic pulses to treat skin and subdermal fat and improve muscle tone. Providers can use the workstation to perform Tite, Trim and/or Tone treatments, each of which can be customized to the patient’s needs. “Today’s patients are seeking a customizable and effective solution for their aesthetic goals. This is the ﬁ rst time that I have the ability to offer a noninvasive solution tailored to my patient’s needs,” said plastic and reconstructive surgeon Erez Dayan, MD. “The Evolve platform is clinically the most effective solution 7 available for the treatment of skin, fat and muscle. With the great results that are achieved, we see high levels of patient satisfaction.” Contact: 855.298.7347, inmodemd.com. 7 DISPOSABLE DERMAPLANING BLADE Cincinnati Surgical offers a disposable 10R blade scalpel—better known as the butter blade—designed specifically for use in cosmetic dermaplaning procedures. The stainless steel blade is permanently affixed to a blue polystyrene handle, eliminating the need to attach and remove the blade from a handle. It is ideal for contouring the nose, mouth and brows. The rounded (bull nose) tip prevents any accidental snagging or scratching thus providing a more effective and consistent finish. The sterile scalpels are 8 sold in boxes of 10, and there is a plastic guard over the blade of each scalpel. Contact: 800.544.3100, cssurgicalproducts.com. 8 COMFORTABLE FAT REDUCTION The LIPOcel body contouring device from Jeisys Medical is FDA- cleared for the treatment of subcutaneous adipose tissue. The device uses focused ultrasound to heat and destroy fat cells and is equipped with contact cooling for a pain-free, noninvasive treatment with no downtime. The contact cooling in the handpiece brings skin down to 5 degrees Celsius to protect the epidermis, decrease discomfort and allow for the emission of high-intensity energy for more effective fat destruction. Contact: 844.737.4433, perigee.com.

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Shopping the Competition How to investigate your direct competitors and perform a competitive analysis of your practice.

Shop your competition? Why on earth would you do that THE PATIENT EXPERIENCE when you’re already so busy with your own aesthetic Your mystery shopper should especially note the following practice? Because you can learn a lot about your own areas that impact the overall patient experience: the facility, business by seeing what other practices do well and what the ambiance, the consultation and overall impressions. they do poorly. Furthermore, the information you gather PHYSICAL LOCATION when investigating your competitors can help you identify • Is your competitor in a standalone building, medical your practice’s stengths, weaknesses and unique attributes. offi ce building or a strip mall? I recommend investigating your local competitors at • Is the location easy to fi nd? least once a year with the following goals in mind: • Is convenient and adequate parking nearby? 1. Evaluating your competitor’s customer service • How easy is it to access the facility? 2. Identifying and assessing the products and services • Is the facility clean and inviting? they offer AMBIANCE 3. Discovering your competition’s fl aws or weaknesses • When you called the practice, was the phone answered 4. Identifying your practice’s unique characteristics, which within three rings by a human or was there an answering can help guide your marketing efforts machine or voicemail? Were you put on hold? In order to gain a clear picture of the practice, you want • Did the receptionist ask for your name and contact to experience it through the eyes of a patient. The most information? effective way to do this is to send a mystery shopper to the • Were your questions answered? competitor’s business. Your mystery shopper could be a • Were you invited to make an appointment for a

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The organizational method you use is less important than your decision to review and act on the information gathered.

• Did the receptionist provide information about the hours YOUR COMPETITIVE ANALYSIS of operation? Once you’ve gathered this information, you can compare • Did the front desk employee offer a smile and a warm it to your own practice and perform a competitive analysis. greeting to those entering the facility? (To ensure you are making a true comparison, I recommend THE CONSULTATION hiring a mystery shopper to visit your own practice as well.) • How long did you wait to see the provider? A competitive analysis identifi es who your key competitors • Did the staff and/or provider ask about your needs are, what products and services they offer, pricing, their and concerns? competitive strengths and weaknesses, the strategies they • Did they build a good rapport with you? are using to meet their goals and the overall market outlook • Did they understand your concerns and recommend for your business. products/services to address those concerns? You can fi nd templates online that will help you organize • Did they discuss the features and benefi ts of the the information identifi ed by your mystery shopper and products/services offered, including downtime and perform the analysis. But the organizational method you number of sessions required? choose is less important than your decision to review and • Did you feel pressured to buy? act on the information gathered. • Did the provider or another staff person close the sale by Once you have compiled and entered the information asking you to book an appointment? from your mystery shopping into the template, hold a staff • Did they ask for the best contact and time to follow-up? meeting to share the results of the competitive analysis. • Did they thank you for coming in? Discuss the outcomes and look for areas of differentiation OVERALL IMPRESSIONS as well as areas for improvement. For example, do your • Did the staff make you feel welcome and valued? providers hold certifi cations that no one else in your area • Was the experience positive, negative or exceptional? has? Are your prices lower—or signifi cantly higher—than those of your competitors? Do you offer a more convenient COMPARING PRODUCTS location with better parking and superior customer service? AND SERVICES These points of differentiation should be highlighted in your One way to differentiate your practice is to identify what marketing message and shared with prospective patients you offer that no one else in your area can provide. In in the initial phone call. You can even integrate them into a addition to reporting on the aforementioned criteria, ask practice tag line that is included on your website, service your shopper to obtain a copy of the service menu and ask menu and phone greeting. about prices, specials and bundling programs available. Be sure your staff is fully engaged in these meetings You also want to obtain information on the certifi cations of by opening with positive comments and then asking for the providers. their feedback. By understanding your practice’s unique Additionally, you want to gain information on your attributes, you and your staff will be better able to attract and competitors’ retail offerings. The range of services offered retain the patients who most value what you have to offer. and price points of both treatments and retail products will give you a better understanding of the competitor’s Cheryl Whitman is founder and CEO of Beautiful Forever, target patient base. For instance, is the practice targeting an aesthetic business consulting fi rm, and Beautiful Forever economy-minded or high-end patients? Are they offering University, which offers educational programs to medspas treatments typically geared toward older or younger and aesthetic practices. Contact Cheryl at Cheryl@

aesthetic patients? beautifulforever.com, 561.299.3909. MELPOMENEM/ISTOCK

22 MARCH 2020 | MedEsthetics Ellipse IPL™ Pigmentation

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Light changes everything. ũ&DQGHOD&RUSRUDWLRQ7KLVPDWHULDOFRQWDLQVUHJLVWHUHGDQGXQUHJLVWHUHGWUDGHPDUNVWUDGHQDPHVVHUYLFHPDUNVDQGEUDQGQDPHVRI&DQGHOD&RUSRUDWLRQDQGLWVDĴOLDWHVAll other trademarks are the property of their respective owners. All rights Ellipse1. reserved. Nordlys September Bjerring 2. clearance 510(k) et al. 2016. PU04151EN-NA Lasers Negishi 2. P, (K161162), Surg K, et al. Med.Dermatol 2004;34(2):120-126. Surg. 2006;32(11):1380-1387

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candelamedical.com | 800.733.8550 LEGAL ISSUES | By Alex R. Thiersch, JD

Needle-Free Injectors What you need to know before considering hyaluronic acid atomizers.

In the past several months, you may have noticed ads, skin. The jet is generated using gas or spring pressure social media posts, articles, videos and training events to force the medicine through a small opening in a talking about an “incredible” new injection device disposable vial. The purported benefi ts include lower that can place hyaluronic acid fi ller in the skin without risk of cross-contamination, reduced needle-stick using a needle. These devices are often marketed as injuries and less sharp medical waste. This makes “noninvasive” or “nonmedical,” using names such as these devices particularly well-suited for inoculation “hyaluron pen” or “hyaluronic acid atomizer.” campaigns, clinics and home self-administration of Although they do not have needles, these products insulin or other medications. are medical devices and should be treated the same as Several needle-free injection devices have received traditional syringes. In the United States, administering FDA approval for use with specifi c drugs. For example, medication, no matter the method used, is part of in 2014 a needle-free injector manufactured by each state’s defi nition of the “practice of medicine.” PharmaJet and Seqirus Pty. Ltd.—manufacturer of Therefore, any person wanting to administer treatment the infl uenza vaccine Afl uria—received approval to with a needle-free injector must have the same type of administer the Afl uria vaccine using the PharmaJet professional license required to inject using a needle Stratis injector for patients 18 to 64 years old. The FDA and syringe. In addition, the U.S. Food and Drug made clear, however, that it still recommends sterile Administration (FDA) has not approved any needle-free needles and syringes for other vaccines and for patients injector for use with hyaluronic acid fi llers, meaning younger than 18 and older than 64. practitioners should not be marketing these treatments. These injectors are regulated through the FDA But should you offer them? premarket notifi cation process under the 510(k) provision. These premarket notifi cations are granted when a new NO NEEDLE, NO PROBLEM? device is substantially similar to an existing approved device, Needle-free injection devices generally are used to and they allow the manufacturer to begin marketing the deliver vaccines and medications either intramuscularly product while it complies with the more lengthy registration or subcutaneously, similar to a traditional needle and and approval process. In order to be cleared through this syringe. They work by creating a very narrow high- process, at least one drug or injectable substance must

pressure jet of medication that is able to penetrate the already be approved for this method of injection. PAVELIS/ISTOCK

24 MARCH 2020 | MedEsthetics Light Therapy

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The FDA has approved a number of hyaluronic acid- the pros and cons before integrating this off-label use based fi llers for injection using either the traditional needle into their practice. and syringe method or cannula. Thus far, no hyaluronic acid fi llers have been approved for use in needle- HOME USE CONCERNS free injectors. So, any pen injector cleared under the The majority of the hyaluronic pens currently listed online premarket category may not legally be marketed for use are packaged with a supply of hyaluronic acid and with hyaluronic acid-based fi llers. marketed for at-home personal use. Surprisingly, there are relatively few legal issues for those wanting to treat PROFESSIONAL CONSIDERATIONS themselves. While non-FDA-approved hyaluronic pens Medical aesthetic professionals interested in bringing can’t legally be sold, they can be possessed for personal needle-free devices into their practices need to consider or nonmedical use. two questions: Can I legally offer these treatments Furthermore, people are generally free to do and should I? Physicians generally are able to use things to themselves that would normally require otherwise-approved devices and drugs in ways that a professional license if performed by another. For are not yet approved by the FDA. This is known as example, you can cut your own hair without a barber’s “off-label use,” and it is the source of a great deal license, you can write your own contracts without a law of innovation and advancement in the medical fi eld. license, and you can treat your fever without being a However, physicians are not allowed to advertise and doctor. Similarly, someone can possess a jet injector promote off-label uses. Additionally, using unapproved for their personal use, as well as possess syringes and devices in an unapproved way can create standard-of- scalpels if they so choose. It is worth noting, however, care and liability issues for the practitioner if the patient that in some states, possessing prescription drugs experiences an adverse outcome. and substances—such as injectable hyaluronic acid So, while it would not be advisable for a nurse or fi ller—without a prescription is prohibited. And offering physician to purchase one of these unapproved, illegally to perform these treatments on others is considered marketed devices off eBay, for example, a physician practicing medicine without a license. could take an FDA-approved needle-free injector and From a practical standpoint, people should think repurpose it for injecting FDA-approved fi llers, so long carefully before choosing to perform medical procedures as they did not market or advertise this practice. The on themselves. The jet injectors being sold are not question then becomes—does it make sense to do this? designed for this use—they appear to be rebranded and Do such devices bring additional capabilities over the repurposed injectors that are not approved in the U.S. current syringe-and-needle techniques? The hyaluronic acid fi llers sold with them and available While many of the approved devices allow for the online are not approved for injection into humans, either, dosage per “fi ring” to be metered, it does not appear and often are of unknown sterility, safety or quality. that the placement of the medication can be done as The public should be extremely wary of using precisely as using a syringe and needle—there is no way these devices, and under no circumstances should to ensure that the fi ller is injected in the precise location anyone perform this treatment—or any other cosmetic or depth, or in the amount desired. According to studies injectable—unless they hold an appropriate medical conducted by jet injector manufacturers, the amount of license. Licensed healthcare professionals should the drug that is actually delivered and the precise location educate their patients about the risks of these at-home, of delivery can vary from injection to injection. The depth unapproved products and should always carefully and penetration also can be infl uenced by tissue density, consider the benefi ts and risks of adding a new or novel the angle of the injector to the skin and the pressure treatment to their own practices. applied against the skin prior to fi ring. While these variables can be within acceptable limits Alex R. Thiersch, JD, is a healthcare attorney who for administering vaccines and medications, would they represents medspas and aesthetic medical professionals. be acceptable for cosmetically treating someone’s lips or He is the founder and CEO of the American Medical Spa face? Newer devices may remedy some of these issues, Association (AmSpa) and partner at ByrdAdatto Law Firm. but any licensed practitioner should carefully consider Contact him at [email protected].

26 MARCH 2020 | MedEsthetics

LED devices are gaining new attention as effective, pain-free aesthetic treatment options.

By Inga Hansen LIGHT IS ESSENTIAL FOR ALL LIVING ORGANISMS, AND ITS POWER HAS BEEN HARNESSED BY MAN TO HEAL, GROW AND DESTROY. In aesthetic medicine, lasers are the most widely used light-based devices. But many practitioners are also working with light-emitting diodes (LEDs) to calm inﬂ ammatory conditions, such as acne, rosacea and dermatitis, and rejuvenate aging skin. While lasers emit single wavelength coherent light, LEDs emit light typically in a range of about 10nm in a noncoherent (or nonfocused) manner. “The end result of a laser is usually at least some destruction of the tissue, whereas an LED creates biochemical changes within the tissue,” says Mark E. Richards, MD, a plastic surgeon with Ageless Impressions

Plastic Surgery Institute in North Bethesda, Maryland. PUHHHA/ISTOCK

28 MARCH 2020 | MedEsthetics

LIGHT THERAPY

the February 2018 issue of the Journal of Clinical and Aesthetic Dermatology. In studies using blue light alone, subjects showed a 25 percent to 60 percent decrease in acne lesions. Studies combining blue light with a red light LED system led to a mean improvement of 77.9 percent after eight treatments (two treatments per week for four weeks, Journal of Cosmetic Laser Therapy, 2006;8:71-5). Comedones did not respond as well as inﬂ ammatory acne to the red and blue light treatments. “There are some new companies that have devices that emit red and blue light at the same time, but I tend to do three red light treatments and then one The UltraSlim uses 635nm red light LEDs at high energy to deﬂ ate fat cells. blue. I typically wait 48 hours in between sessions,” says Dr. Ablon.

The most widely used LEDs in aesthetic medicine include blue light, red light and infrared light. Glynis Ablon, MD, Ablon Skin Institute and Research Center in Manhattan Beach, California, and associate clinical professor of dermatology at the University of California, Los Angeles, has studied the use of LEDs and regularly treats patients with them in her practice. “Exposure to LEDs increases adenosine triphosphate (ATP), upregulates nitrous oxide, helps with transcription factor production and offers collagen synthesis,” she says. “Blue light can be antibacterial. Red is anti-infl ammatory, and you’ve also got the infrared light, which can stimulate collagen Dr. Richards’ practice offers acne treatments that synthesis. We have two LED systems in our practice, combine extractions and red and blue light to address and they run all day long.” the multiple manifestations of acne. His estheticians also perform microdermabrasion or a chemical peel prior to LED therapy to improve penetration of the light. One of the most popular indications for LEDs in “Acne patients get a full facial treatment that includes dermatology and aesthetics is acne. Blue light in blackhead and comedone removal, exfoliation either with the 409-419nm range helps destroy acne-causing microdermabrasion or a HydraFacial or chemical peel Propionibacterium acnes (P. acnes), while the anti- to get the debris off the skin, and then blue or red light infl ammatory power of red light (633nm) helps calm treatment. We treat them every couple of weeks during an infl ammatory acne. “Blue light is effective for treating P. outbreak and then monthly for maintenance,” he says. acnes because it produces the strongest photoactivation of endogenous porphyrins through a process known as endogenous photodynamic therapy (PDT). The The anti-infl ammatory action of red light also can be used result is free radical formation and destruction of the P. to calm the skin of patients with rosacea and dermatitis. acnes cell membrane,” Dr. Ablon explains in her paper, “The most common indications for red light in my

“Phototherapy with Light Emitting Diodes,” published in practice are acne, rosacea and rashes,” says Dr. Ablon. PHOTO COURTESY OF WARD PHOTONICS

30 MARCH 2020 | MedEsthetics

LIGHT THERAPY

in the cells. “This stimulates fi broblast proliferation, collagen synthesis, growth factors and extracellular matrix production,” explains Dr. Ablon. For their 2007 randomized, double-blind, controlled study on LED therapy for skin rejuvenation (Journal of Photochemistry and Photobiology B: Biology), researchers Seung Yoon Lee, et Rosacea patient before and after seven sessions with an in-offi ce red light LED device. al, treated 76 subjects with 830nm infrared (Group 1) and 633nm red (Group 2) LEDs alone or together (Group 3) and performed punch biopsies in four to six subjects within each group. The percentage of subjects with improvement in both melanin and wrinkle severity was signifi cantly higher in all treatment groups (95.2 percent, 72.3 percent and 95.5 percent, respectively) compared to the “You can use red light for anything that is infl ammatory.” sham treatment group (13.3 percent). Biopsies revealed When treating patients with rosacea, she fi nds that increased collagen, highly activated fi broblasts and an the red LED is most effective at reducing the diffuse increase in the size and number of collagen and elastin redness and the papules and pustules. “If someone has fi bers in all treatment groups. prominent vessels that I can see, I start with the LED Still, the outcomes in skin rejuvenation are modest just to bring down the infl ammation, then I would turn when compared to more aggressive treatments, notes to either an IPL or a vascular or pulsed dye laser,” says Dr. Ablon. “I see mild, mild improvement. I’m not Dr. Ablon. “But if I’m looking at just the overall blush of wowed,” she says. “I’d rather sneak an IPL in there if I’m rosacea with papules and pustules, then I go straight to really looking for rejuvenation of photodamaged skin.” the LED, and we see great results.” Patients with rosacea or dermatitis typically need six to eight sessions spaced one week apart. “For a rash, I LED therapy is also gaining in popularity as a noninvasive have patients who do one or two treatments and they’re treatment option for body contouring. “Both red and clear. For rosacea, I usually see a big change after the green low-level lasers disrupt the fat cells and cause some third or fourth session,” says Dr. Ablon. lipolysis and shrinkage of the fat cells,” says Dr. Ablon. Red light is also used by both Dr. Ablon and The red wavelengths target the mitochondria of the fat Dr. Richards postprocedure for patients who have cells and cause them to release a cellular hormone that prolonged erythema. “I will use red light postprocedure opens up the pores on the cell membrane. “The fat leaks if I have someone who’s really, really red,” says Dr. out of the cells, and the treatment keeps those pores Ablon. “It’s not great for bruising. If I want to take away open for about 36 hours, allowing the fat cells to defl ate,” bruising, I typically use a laser.” says Dr. Richards. Much of the research on the use of low-level laser therapy using red light came from Erchonia, which makes It is well proved that thermal technologies, including the Zerona laser. “This is a low-power 635nm laser that lasers and radiofrequency-based devices can stimulate opens up the fat cell membranes,” says Dr. Richards. the production of collagen to deliver younger-looking “The problem is, the beam is the size and power of a skin. LEDs can also rejuvenate skin through a penlight, and you have to wave that penlight all over the mechanism known as photobiomodulation, wherein place to create the biochemical changes that open up

absorption of photons activates mitochondrial pathways the fat cells.” ABLON, MD PHOTOS COURTESY OF GLYNIS

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Most patients seek the treatment to reduce fat in their abdomen or ﬂ anks, but Dr. Richards has also seen good results with arms. “We had a bride come in because her arms were really tight in her wedding dress. It was too close to the wedding date to do any kind of liposuction, so we did the UltraSlim on the arms,” he says. “She had four treatments and lost an inch in circumference. She was thrilled.” In addition to offering pain-free treatments with no downtime, LED systems offer good ROI to aesthetic practices. Nonmedical providers can operate the devices and the systems require little maintenance compared to other light- based devices. “My two machines are from Omnilux, and I rarely have anything that needs to be ﬁ xed,” says Dr. Ablon.

Building on the effectiveness of the 635nm low-level laser, engineers at Ward Photonics created the UltraSlim, an LED device that uses noncoherent light in that same 635nm wavelength range, but at a signifi cantly higher power. Robert Burke, MD, of the Michigan Center for Cosmetic Surgery in Ann Arbor, Michigan, studied the UltraSlim and presented his data at the 2018 International Society of Aesthetic Plastic Surgery meeting. The IRB-approved, placebo-controlled study included 15 subjects. Each underwent six 32-minute treatment sessions to the abdomen and upper legs. In treated subjects the average dimensional loss was 7.2 inches in the She encourages practitioners to beware of the “no abdomen and 2.3 inches in the upper legs. Average pain, no gain” mentality. “We are learning that you don’t weight loss was 4.6 lbs. There was no significant have to have pain to see results. In my practice we use weight or circumferential dimension loss in the these machines every single day, multiple times a day, placebo group. with great results,” she says. “The UltraSlim has much more energy than the Dr. Richards also sees a bright future for LED Zerona. That power overcomes the difference between technology. “If it’s destruction of some particular tissue the focused and nonfocused beam. And it allows you to that you want, then a laser is ideal. If it’s a change treat a much larger area in one session,” says Dr. Burke. in the nature of the tissue, then LEDs are really the Both Dr. Burke and Dr. Richards typically better option. You just need to explore all the different recommend six sessions. “In general, people with wavelengths. There are likely dozens and dozens of looser or fl uffi er fat can have really dramatic changes. wavelengths that can do all sorts of wonderful things People with fi rmer, more fi brous fat may fi nd that their that we haven’t even discovered yet,” he says. clothes fi t a little bit better after six treatments, but they

don’t change sizes,” says Dr. Richards. Inga Hansen is the executive editor of MedEsthetics. DRAGONIMAGES /ISTOCK

34 MARCH 2020 | MedEsthetics

DUAL DEGREES Is pursuing an additional advanced degree right for you?

By Stephanie Kramer

For Jorge Garcia-Zuazaga, MD, MBA, the turning point me thinking, ‘I could do something on my own,’” he came 10 years after medical school. While working at says. “It gave me greater conﬁ dence to take the risk a university hospital, he saw that patients had to wait and set up my own practice.” up to six months for an appointment. He had long The risk paid off. Since founding Apex Dermatology wanted to open his own practice, and believed it could & Skin Surgery Center, the practice has grown from a help improve access, but leaving his job in academia single ofﬁ ce to seven locations across Northeastern Ohio. seemed risky. When he won a career development Until recently, many doctors steered clear of the award from a local foundation, he made his move. business side of patient care. But according to Maria He enrolled in an executive Master’s of Business Chandler, MD, MBA, president of the Association of Administration (MBA) program at Case Western MD/MBA Programs, about 50 percent of all medical Reserve University’s Weatherhead School of schools now have the option to pursue a dual Management. It was two years of evening and degree. As more practitioners are discovering, the weekend classes, but instead of being stressed out, added expertise can have an enormous impact on it sparked his entrepreneurial spirit. “It jump-started their careers. HXDBZXY/ISTOCKPHOTO; ERDRE/ISTOCKPHOTO HXDBZXY/ISTOCKPHOTO;

MARCH 2020 | medestheticsmagazine.com 37 DUAL DEGREES

Dual Degrees on the Rise An additional degree may be useful for physicians who want to move up the managerial ladder at a hospital or do consulting for a biotech company. But what about aesthetic providers in private practice? For them, it’s especially important, says Josh Waltzman, MD, MBA, founder of Waltzman Plastic and Reconstructive Surgery in Long Beach, California. He graduated with a joint degree from the University of California, Irvine, in the early 2000s. “Aesthetic patients are looking for an experience,” he says. Doctors may think their performance is evaluated based on clinical skill alone, but other factors infl uence how patients perceive the quality of treatment. “You can perform the surgery or provide good medical services, but there’s a lot more to it when it comes to the aesthetic patient,” says Dr. Waltzman. “That’s where the business side comes in.” Practice design, location, waiting times and offi ce atmosphere all contribute to the patient’s overall “Business has its own language, just like medicine,” experience and satisfaction. says Dr. Waltzman. An advantage of an MBA is it teaches Dr. Chandler, founder and former head of the MD/ physicians how to “talk the talk” when working with MBA program at UC Irvine, has seen an increase in the investors, accountants, attorneys and marketing experts. number of plastic surgeons graduating with joint degrees. A nonmedical degree can also expose doctors (The university also offers a healthcare MBA for mid-career to new ideas and concepts. Vinod Nambudiri, MD, professionals.) Despite the rise in dual degrees overall, the MBA, an assistant professor in the department of percentage of doctors in each program remains small, dermatology at Brigham and Women’s Hospital in ranging from two or three students in a class of about 25, Boston, completed a joint MD/MBA program at Harvard meaning many physicians still leave their residencies with University. He soon learned one of the key differences little business management training. between business and medicine. “In the business “Doctors aren’t necessarily taught how to be good world, there’s a lot more decision-making using much businesspeople,” says Dr. Waltzman. His MBA familiarized less reliable evidence,” he says. him with marketing, fi nance, accounting and legal The experience greatly improved his ability to “think issues as well as skills for creating a business plan and outside the box,” says Dr. Nambudiri. “I hadn’t contemplated structuring a business. This inspired him to hit the ground how valuable that would be in terms of being willing to running and set up a solo practice right out of fellowship. experiment or innovate or go outside the boundaries and Knowledge of business administration can determine think about alternative solutions to a problem.” whether a practice thrives. “You need to know where your Physicians are often in charge of university programs dollars go—what goes to overhead, supplies, the doctors’ and hospital departments, where they are responsible for salaries and staff salaries,” says Dr. Garcia-Zuazaga. “It’s huge budgets and must make decisions about staffi ng important to understand how everything comes together. and equipment. “Getting an MBA helped prepare me for If you have an understanding of the business side of certain administrative and leadership roles like overseeing medicine, you can do things more effi ciently, which also a residency program, recruiting trainees, managing crises improves patient satisfaction and patient care.” as they unfold and strategically thinking about developing the program over time,” says Dr. Nambudiri. Speaking the Language In addition to teaching finance, strategy and While some doctors prefer to focus on patient care, others communication skills, business training emphasizes enter the fi eld with the goal of solving the challenges teamwork. “When you work in the real world, you’re not in health care through population health, department doing it all by yourself,” says Dr. Garcia-Zuazaga. “Picking the management or product innovation. The fi rst challenge right team and surrounding yourself with the right advisors is

they often face is making their ideas understood. very important. Health care is not a one-person job.” FATCAMERA/ISTOCKPHOTO

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Connect with us! DUAL DEGREES

Natalie Curcio, MD, MPH, founder of Curcio Dermatology in Nashville, received a Master of Public Health (MPH) from Vanderbilt University. The advanced degree has benefi ted both her patients and her career. “After you get your MPH you realize you’re really not taught in medical school how to clinically analyze studies,” says Dr. Curcio. “This ability to clinically evaluate evidence not only makes you a better physician in clinical practice, but it also creates leadership opportunities.” MPH Benefits An MPH includes courses such as biostatistics and care, quality improvement or patient safety, then an MPH epidemiology, covering health research methods, health may be a good fi t. policy and analysis for healthcare improvement. “The The value of an MBA is that it teaches entrepreneurial MPH teaches you how to assess large data sets in skills that are not part of the medical school curriculum. order to solve a problem,” says Dr. Curcio. “With a These include accounting, marketing, operations clear understanding of both the methods and analysis management and business law. The degree can give you of clinical or scientifi c research, one can clearly and an edge if you want to go into hospital administration confi dently analyze any published scientifi c paper and or run a start-up. Some people claim that every private decide if the study is fair and just, and if the conclusions physician needs an MBA. Yet life experience also matters. are justifi ed.” Dr. Garcia-Zuazaga says his military experience as a Her MPH led to unexpected opportunities almost Marine fl ight surgeon was as important to growing his immediately. After completing her residency and fellowships, practice as his MBA, because it helped him develop a she was asked to apply her knowledge of clinical research sense of responsibility and leadership. to evaluating lasers and other new technologies. “My ability Dr. Curcio advises physicians considering an additional to analyze data, both clinical and scientifi c, to fi nd the degree to “go for it and go for it early.” epidemiology of a health outcome or a disease; my ability Dr. Nambudiri concurs, provided you are pursuing a to problem-solve, perform analysis of current issues or path that will allow you to put those additional skills to products, offer ideas for innovation, and create or perform work. “It comes down to how you put to use the skills that new studies [has been] very valuable,” she says. you acquire,” he says. “If you take a year or two early in your career and invest it in additional training, and if you To Pursue or Not To Pursue? put that to use, you could have a 20- or 30-year career Obtaining an MBA or MPH can benefi t physicians at period where you’re reaping the benefi ts.” every stage of their careers, from student to mid-career Entrepreneurial doctors and those who desire to shape professional and later, but not everyone needs or wants the future of health care can benefi t from an additional more letters after their name. “If you’re going to spend degree. “It gives you a greater perspective that makes your $100,000 on an extra degree, ask yourself ‘What is the clinical work and your career more rewarding because return on investment?’” says Dr. Garcia-Zuazaga. “The it allows you to broaden the breadth and depth of your question is, ‘Where do I see myself in fi ve years and how impact,” says Dr. Curcio. “You’re infl uencing the whole do I get there? Do I need to have an MBA? Or do I need medical fi eld and patient care on a more global scale.” to have an MPH? Do I really want to be the chair of a She admits it’s a heavy workload, but she’s glad she department or own my practice?’” did it. “If your heart’s in it, you can make it work, because An MPH gives you expertise in healthcare policy and you’re enjoying what you’re doing,” she says. “Follow your management. It prepares you for designing and managing life’s passion with enthusiasm. It won’t feel like work when health programs, overseeing funding, dealing with you love what you do.” changing regulations and understanding population-based research methods. If you are interested in infl uencing Stephanie Kramer is a freelance writer who specializes in

health at the community level, or getting into preventive health care. DNY59/ISTOCKPHOTO

40 MARCH 2020 | MedEsthetics

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42 MARCH 2020 | MedEsthetics

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44 MARCH 2020 | MedEsthetics

THE MINIMALIST Dermatologist Sapna Palep, MD’s own struggle with acne and her extended family’s skin diseases sparked her pursuit of beauty and health for her patients.

By Echo Montgomery Garrett ♦ Photography by Kevin Brusie

apna Palep, MD, got an early inside look at a career in medicine. Her father, a busy gastroenterologist in Miami, would often take her with him to the hospital when he was on call on weekends. “What he did was fascinating to me,” says Dr. Palep, who at 19 became the country’s youngest student to be accepted into medical school. SAfter two years attending the University of Miami School of Medicine, she transferred to New York Medical College where she graduated in 2004. That same year, Dr. Palep graduated with a Master’s of Business Administration from the Lubin School of Business at Pace University, where she majored in Health Systems Management as preparation to run her own practice. Her own struggle with acne and the skin problems—including psoriasis and vitiligo—of several extended family members sparked her interest in dermatology. “A lot of skin diseases are hereditary, and my family asked me about new research all the time,” says the Florida native. “Once I did my rotation as a resident in dermatology, I was hooked.”

MARCH 2020 | medestheticsmagazine.com 47 THE MINIMALIST

Spring Street Dermatology offers personalized care in a calm environment for busy New Yorkers.

“I am not trying to sell my patients the newest thing. I’m a minimalist, and I take a personalized approach. I don’t treat every face the same."

She then went on to the Mount Sinai Medical Center through it myself. At times I wouldn’t even leave my for her specialty training in dermatology. Currently, apartment. I can’t tell you how many people cry on Dr. Palep is a clinical instructor in the Mount Sinai my shoulder. The skin is what you see when you look department of dermatology. at a person, so anything that hurts the skin can affect During residency, she worked closely with Mark G. self-esteem and self-confi dence. That becomes a Lebwohl, MD, chair of Mount Sinai Medical School’s dermatology emergency.” dermatology department, who became her mentor. Dr. Palep spent two years at Mount Sinai studying skin cancer full time. Her research focused on the Building a Practice carcinogenic effects of UV radiation on DNA, and her work was published in the Journal of the American Her brand logo, a lotus fl ower, represents regeneration in Association of Dermatology, the Journal of Cutaneous Eastern culture. “I wanted the atmosphere in my offi ce to Pathology and the Journal of Investigative Dermatology. be peaceful and beautiful, and I wanted patients to feel She served as chief resident from 2008 to 2009. like family,” says Dr. Palep. The practice features natural “I love bench research and biochemistry,” she says. “I wood fl oors and light, calming wall colors. wanted to get down to the cellular level and understand Not long after opening her practice, Dr. Palep added what protects the skin and what doesn’t.” cosmetic treatments to her offerings, which now include In 2010, the newly minted board-certifi ed Botox, chemical peels, dermal fi llers, microneedling and dermatologist founded Spring Street Dermatology resurfacing lasers. Her practice is split 50/50 between in SoHo in New York City, specializing in acne. “I cosmetic and medical. “I want to be a one-stop shop that am patient about clearing people,” she says. “I went can take care of all of our patients’ skin needs,” she says.

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In December, Dr. Palep launched her third ofﬁ ce in New York City.

Often after treating one family member, she will begin treating their entire family. “Usually the wife will come fi rst and then the husband,” she says. “I have at least 10 families where I see all of them. I feel like I’m part of their families, and that’s a real privilege.” For the fi rst decade, she relied entirely on word of mouth to build her patient base. “I didn’t spend one dollar on marketing until just recently,” says the doctor, who opened a second location early last year in Tribeca and added a third in Midtown in December. She continues to practice in her original SoHo location. you went to that doctor for in the fi rst place? “I am not trying to sell my patients the newest thing. I’m a minimalist, and I take a personalized approach. I A Personalized Look don’t treat every face the same,” says Dr Palep. “You cannot treat patients robotically, because people will not She takes a light touch with cosmetic procedures. “If be happy. One bad experience, and people are out the the people closest to you say you look great and well- door. I pride myself on doing work that looks very natural rested, then I’ve done my job. I don’t want anyone to and aesthetically pleasing.” look different from who they are,” says Dr. Palep. “There When she meets with a new patient, she says, “Look are a lot of scary-looking people out there. I can’t believe at my face. Would you know that I have Botox and fi ller? people look in the mirror and think that looks OK. It Then you get their attention and they trust you. I hand drives me crazy when people spend ridiculous amounts them a mirror and ask what bothers them. From there we of money and wind up with bad results. It gives the fi eld develop a game plan to address any issues. You have to a bad name.” have that vision for someone’s face.” The doctor often asks patients who come to her to Dr. Palep stakes her reputation on hiring other correct the results of a procedure from another provider physicians who share her personalized patient care a simple question: Did that procedure address the issue philosophy. Currently, she has seven doctors and two

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Noninvasive body contouring has become a particularly popular treatment at Spring Street Dermatology.

physician’s assistants on her team. By August, she plans to have 13 doctors. Becoming the Mentor “I train everybody on myself,” says Dr. Palep. “You have to feel how they inject the needle. I’m proud of my After Dr. Palep completed her residency, her mentor team. They are all learners and very caring people.” Dr. Lebwhohl invited her to join his teaching staff at Still, she admits it’s nerve-wracking to train her Mount Sinai. Since 2010—the same year she opened doctors on herself: “I tell them, ‘Don’t mess up my face!'” her own practice—she has served as clinical instructor in the department of dermatology at the Icahn School of Medicine at Mount Sinai. She was presented with the Getting an Early Start Teacher of the Year Award in 2010 and 2012, and the Mentor of the Year Award in 2013. “All residents rotate Dr. Palep didn’t start using injectables and fi llers until with me every Thursday afternoon,” says Dr. Palep. her late 30s and regrets not starting earlier, so she’s For new physicians entering the fi eld, she advises glad to see that millennials and younger patients are fi guring out how you want to practice to suit your increasingly coming in for preventive procedures. lifestyle and your goals. “Some want to work for “Taking steps now to prevent lines and atrophies should somebody else and go home at the end of the day, and eliminate the need for a plastic surgery overhaul later,” others want to own their own practice or be a part- she says. “If it’s a gradual build, then people aren’t owner in a practice,” she says. shocked when you have a more invasive procedure. From the beginning of her career, Dr. Palep— Although it’s never too late, it’s harder when people recognized by The Leading Physicians of the World as come in when they are older.” a Top Dermatologist in New York in 2015 and named Always a researcher, Dr. Palep devotes a lot of a Top Doctor in the New York Metro Area in 2018 by time to ensuring that the technology in her practice is Castle Connolly—knew she wanted everything under best in class. “You have to choose your machines very her full control. carefully,” she says, noting that a single device may top “I think we grew so fast because I set such high $100,000. “I demo all of my machines on patients and standards for patient care,” she says. “Maintaining staff to make certain they operate well, and that the that quality of care while expanding and growing the results are really what was promised.” practice is my biggest concern. Because I’m an owner, She is known as a leader in the fi elds of microneedling everybody’s problem is my problem. If something goes and noninvasive body contouring and is a fan of the latest wrong, that’s on my shoulders. My phone is never off. truSculpt iD machine. “It accomplishes fat reduction It’s the hardest work, and it’s what keeps me up at night. through radiofrequency, which destroys the fat cells,” But I want to leave a legacy of excellent patient care. she says, adding that truSculpt fl ex can also increase Nothing bothers me more than an unhappy patient.” muscle mass. “I can treat six pockets of fat at one time in 15 minutes, and four major muscle groups at one time Echo Montgomery Garrett is a freelance writer based in in 45 minutes.” Marietta, Georgia.

52 MARCH 2020 | MedEsthetics WEBINAR

REDEFINING MUSCLE SCULPTING WITH TRUSCULPT FLEX

Body sculpting is the fastest-growing segment in aesthetic device procedures. Michael Somenek, MD, a pioneer in muscle-sculpting technology, shares his expertise with the new truSculpt ﬂ ex muscle-sculpting device, including how the technology works and how it attracts new patents into the practice.

TUESDAY MARCH 17, 2020 2:00PM PT/5:00PM ET

Michael Somenek, MD, is double board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology and is also a member of the American Academy of Facial Plastic and Reconstructive Surgery. He is the founder of Somenek MD - Advanced Facial Plastic Surgery in Washington, DC. The practice offers cosmetic and reconstructive services.

REGISTER ONLINE AT MEDESTHETICSMAG.COM/WEBINAR View our library of past webinars at medestheticsmag.com/webinar REDNESS RELIEF

Silagen Topical Recovery Formulated for daily as Gel from Newmedical well as postprocedure use, Technology helps reduce EltaMD UV Replenish postprocedure bruising and Broad-Spectrum SPF swelling with 20 percent organic 44 is a chemical-free, 100 herbal Arnica montana and 1.5 percent mineral sunscreen percent vitamin K oxide. The with hydrating hyaluronic acid gel’s active ingredients help calm and antioxidant protection. inﬂ ammation, accelerate vein The oil-free formulation is repair and stimulate processes water resistant and safe to clear leaked blood from the for all skin types. Contact: area. Contact: 866.639.6331, 800.633.8872, eltamd.com. silagen.com.

Epionce Renewal Dewet Coconut Milk Calming Cream soothes Moisture from Induction sensitive, eczema-prone skin Therapies is a lightweight and replenishes moisture in emulsion formulated to rehydrate the skin barrier for long- postprocedure skin. Medical- term relief. The formulation grade hyaluronic acid binds 1,000 includes: colloidal oatmeal to times its weight in water to deliver help condition and moisturize hydration while vitamin A- and skin; meadowfoam, saffl ower C-rich coconut milk restores and apple extract to increase elasticity. Additional ingredients fi rmness and elasticity; lecithin and ellagic acid help soften Rosa canina, a source of skin and provide antioxidant vitamins A, B, C, E and K; protection. Contact: 877.746.4407, vitamin C-rich onion; and inductiontherapies.com. anti-infl ammatory white water lily. Contact: 866.374.6623, epionce.com.

The Finishing Touch Protocol by Colorescience minimizes patient discomfort and postprocedure downtime by concealing, healing and protecting sensitive skin. The protocol includes: Even Up Clinical Pigment Perfector SPF 50, All Calm Clinical Redness Corrector SPF 50, Total Eye 3-in-1 Renewal Therapy SPF 35, Mineral Corrector Palette SPF 20 and Sunforgettable Total Protection Brush-On Shield SPF 50. Contact: 866.426.5673, colorescience.com.

54 MARCH 2020 | MedEsthetics

AESTHETIC TECHNOLOGIES

The Profound RF fractional microneedling device from Candela utilizes temperature-controlled radiofrequency, delivered through insulated microneedles, to restore elastin, collagen and hyaluronic acid. Physicians can control the temperature, treatment time and depth of penetration for more predictable results in a single session. Contact: 508.358.7400, candelamedical.com.

Alma Lasers Beautifi ll is a The HydraFacial is a laser-based system designed nonlaser, hydradermabrasion to optimize the process skincare system that offers of autologous fat transfer. customizable procedures The system combines to improve the appearance 1,470nm laser, suction and of fi ne lines, wrinkles, fat processing into one step, enlarged pores, congested allowing physicians to quickly skin and brown spots. Both harvest and process high- a physical and chemical quality fat for immediate treatment, HydraFacial uses reimplantation. The conical patented technology to tip laser fi ber is encased in cleanse, extract and infuse a protective glass sheath, skin with serums containing which protects adipose tissue antioxidants, peptides and and allows the energy to be hyaluronic acid. Contact: distributed in a 360-degree 800.603.4996, hydrafacial.com. radius. Contact: 866.414.2562, almalasers.com.

The TempSure Envi radiofrequency device from The Vbeam Prima Cynosure minimizes ﬁ ne lines from Candela offers two and wrinkles and improves wavelengths—595nm and the appearance of cellulite 1,064nm—to address a by tightening skin through wide range of vascular soft tissue coagulation. The concerns. The 595nm device features Therapeutic pulsed dye laser deeply Logic Control (TLC), a tool penetrates skin to reach, that links treatment time with coagulate and clear target temperature, allowing targeted blood vessels, for consistent treatment while the 1,064nm temperatures with minimal wavelength treats blue to no pain for patients. The veins, venous lakes no-downtime treatments are and minimizes wrinkles. safe for all skin types. Contact: Contact: 508.358.7400, 800.886.2966, cynosure.com. candelamedical.com.

56 MARCH 2020 | MedEsthetics WEBINAR

UPDATES ON ACNE

Join us to learn about new technologies and protocols in acne treatment, and their impact on your practice and patients.

WEDNESDAY MARCH 4, 2020 11:00AM PT/2:00PM ET

Presented by:

Kseniya Kobets, MD, board-certiﬁ ed dermatologist with Skin Laser & Surgery Specialists of NY and NJ.

REGISTER ONLINE AT MEDESTHETICSMAG.COM/WEBINAR View our library of past webinars at medestheticsmag.com/webinar NEWS & EVENTS

SEBACIA ACQUIRES SIENNA PHOTOPARTICLES • Henry O. Gosebruch, executive vice president, chief Sebacia, maker of Sebacia Microparticles for the treatment strategy offi cer of acne, recently acquired all assets related to Sienna • Robert A. Michael, executive vice president, chief Biopharmaceuticals’ SNA-001 (silver photoparticle technology). fi nancial offi cer The acquisition includes all related intellectual property owned • Timothy J. Richmond, executive vice president, chief or licensed by Sienna as well as the 510(k) application for human resources offi cer light hair removal, which was submitted to the U.S. Food • Azita Saleki-Gerhardt, PhD, executive vice president, and Drug Administration (FDA) in September 2019. It also operations enables Sebacia to resolve the outstanding patent interference • Carrie Strom, senior vice president, AbbVie, and president, litigation between The General Hospital Corporation (GHC, Global Allergan Aesthetics the owner of certain patents licensed by Sebacia) and Sienna Biopharmaceuticals. ALASTIN RECEIVES “This acquisition enables Sebacia to secure Sienna’s silver THIRD PATENT photoparticle intellectual property (IP), effectively resolving all The U.S. Patent and Trademark existing patent confl icts with Sienna, while also establishing Offi ce has issued a third U.S. Sebacia as a leader in the use of microparticles and laser Patent covering ALASTIN energy in dermatology,” said Chuck Abraham, CEO of Sebacia. Skincare’s TransFORM Body “Consolidating the IP within Sebacia allows us to move Treatment. U.S. Patent No. forward and focus on making our innovative gold microparticle 10,493,011 is entitled, “Peptide treatment for acne available to dermatologists and their Compositions and Methods for patients and gives us an even deeper pipeline of potential Ameliorating Skin Laxity and additional indications.” Body Contour.” The patent is directed to the composition ABBVIE ANNOUNCES POST-ACQUISITION TEAM and uses related to TransFORM Upon completion of its acquisition of Allergan, AbbVie will Body Treatment, both when create a new global business, called Allergan Aesthetics. used alone and when used in Allergan Aesthetics will have its own research and development conjunction with body-shaping function under the AbbVie umbrella and will include leading procedures. aesthetic products including, BOTOX Cosmetic, the “With TransFORM Body Treatment, I am fi nally able JUVEDERM collection of dermal fi llers and CoolSculpting body to provide patients with a topical product that perfectly contouring, among others. complements invasive and noninvasive fat reduction and body Located in Irvine, California, the new company will be contouring procedures and energy-based body sculpting led by Carrie Strom, current senior vice president, U.S. procedures by accelerating results as well as improving skin Medical Aesthetics, Allergan. Upon completion of the Allergan tone and crepiness, ensuring patient’s receive ideal post acquisition, Strom will be named senior vice president of treatment outcomes,” said Laurie Casas, MD, clinical professor AbbVie and president of Global Allergan Aesthetics. She will of surgery at the University of Chicago Medical Center and oversee the worldwide operations, along with an experienced owner of Casas Aesthetic Plastic Surgery. team of current Allergan leaders, and report directly to Richard “As we expand the ALASTIN portfolio, our patented TriHex A. Gonzalez, chairman and CEO of AbbVie. Technology formulations continue to be the building blocks of The “Eye Care and Specialty” businesses, including our ongoing success,” said Diane S. Goostree, CEO of ALASTIN BOTOX Therapeutics, Central Nervous System, Women’s Skincare. “We are proud to be enhancing the outcomes desired Health and Gastrointestinal Diseases, will be integrated into by our physician customers and their patients.” the existing AbbVie organization. The following individuals will make up the executive leadership team of the combined REPLICEL ANNOUNCES INCOMING companies: BOARD MEMBERS • Richard A. Gonzalez, chairman and CEO RepliCel Life Sciences, a regenerative medicine company and • Laura Schumacher, vice chairman, external affairs and maker of autologous cell therapies RCS-01 for skin rejuvenation chief legal offi cer and RCH-01 for hair restoration and proprietary injection • Michael E. Severino, MD, vice chairman and president device, RCI-02, has announced the election and appointment • Carlos Alban, vice chairman, chief commercial offi cer of its incoming Board of Directors.

58 MARCH 2020 | MedEsthetics WEBINAR

MAKING SENSE OF SUNSCREEN NEWS

For decades, we’ve been giving patients the simple yet important advice to wear a sunscreen when they’re out in the sun. Recent reporting of studies by the FDA has raised potential safety concerns about some sunscreens yet emphasized the importance of using sunscreen to help protect your skin from UV rays. Are your patients confused? Join us for an update on the status of sunscreen regulations, the differences between sunscreens, and the easy ways to talk to your patients about sun protection. THURSDAY MARCH 26, 2020 11:00AM PT/2:00PM ET

Presented by:

Dr. Harry Fallick, plastic Amanda Barretta, surgeon, and founder and CEO of licensed esthetician, trainer Fallene Ltd., the maker of TIZO. and educator .

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The re-elected directors are David Hall diffi cult to do so in a manner that properly May 2-5 American Association of (chair), Peter Lowry, Andrew Schutte, refl ects their professionalism and provides Plastic Surgeons Annual Meeting, Peter Lewis, Larissa Huang and Lee meaningful benefi t to their patients,” says Palmer House Hilton, Chicago. Contact: Buckler. The board also increased its Mark Becker, MD, pediatrician, founder 978.927.8330, aaps1921.org members from six to seven and elected and CEO of Vivacare. “Vivacare’s goal is May 8-11 Music City Scale: Zhan (Gavin) Ye to join the returning to make it easy for professionals to share Symposium for Cosmetic Advances & members. Ye has a Bachelor’s of Science their expertise and build a strong online Laser Education, Music City Center, from the Technical University of Delft (The presence, while delivering content and Nashville. Contact: 781.793.0088, Netherlands) and a Bachelor’s of Science tools that support their patients.” scalemusiccity.com for the University of Victoria (Canada). His For more information, visit vivacare.com. May 14-16 World Congress on Anti- background is in the fi nancial services Aging Medicine Spring Conference, sector, the commodity exchange industry Gaylord Palms Resort & Convention and, most recently, in international EVENTS Center, Kissimmee, FL. Contact: product development and brand building March 8-10 International Esthetics, 561.997.0112, a4m.com driven by deep data analytics. Cosmetic and Spa Conference, Javits May 14-17 Advances in Rhinoplasty, “As RepliCel expands the development Convention Center, New York City. Fontainebleau Miami Beach, Miami. of its products internationally with a Contact: 203.736.1699, Contact: 703.299.9291, aafprs.org particular focus on Asia, we anticipate iecsc.com May 28-30 31st European Association Mr. Ye will be a valuable addition to March 12-14 ASPS/ASAPS Spring of Plastic Surgeons (EURAPS) Meeting, RepliCel’s Board of Directors,” said Hall. Meeting, Hyatt Regency New Orleans, Hilton Athens Hotel, Athens, Greece. “Gavin has deep cross-border experience New Orleans. Contact: 847.228.9900, Contact: euraps.org between Canada and Hong Kong, China, plasticsurgery.org June 5-6 Facial Aesthetic Conference Singapore, South Korea and Taiwan, which March 20-24 2020 Annual Meeting of and Exhibition (FACE), QEII Centre, we anticipate will play an instrumental role the American Academy of Dermatology, London. Contact: faceconference.com in RepliCel’s business activities in Asia Colorado Convention Center, Denver. June 7-11 Southeastern Society of both with our existing partners and new Contact: 888.462.3376, aad.org Plastic and Reconstructive Surgeons partnerships being explored.” April 18-20 International Esthetics, Annual Meeting, The Sanctuary, Cosmetic and Spa Conference, Kiawah Island, South Carolina. Contact: VIVACARE LAUNCHES DIGITAL McCormick Place, Chicago. Contact: 435.901.2544, sesprs.org PHYSICIAN PROFILE SERVICE 203.736.1699, iecsc.com June 10-13 Vegas Cosmetic Digital health fi rm Vivacare has launched April 22-26 Combined Otolaryngology Surgery, Bellagio, Las Vegas. a new service that allows medical Spring Meeting, Hilton Atlanta, Atlanta. Contact: 949.830.5409, professionals to create digital professional Contact: 312.202.5322, vegascosmeticsurgery.info profi les that highlight their clinical cosm.md June 24-27 Maui Derm NP+PA expertise, the conditions they treat and April 23 Aesthetics Innovation Summit, Summer 2020, Broadmoor Hotel, procedures they offer. The profi les include Mandalay Bay Resort and Casino, Las Colorado Springs, CO. Contact: a “Patient Care Toolkit” pre-loaded with Vegas. Contact: 516.765.9005, 831.595.0710, mauiderm.com hundreds of patient education resources attendais.com June 27-29 International Esthetics, designed to improve clinical care and April 23-26 Society of Plastic Surgical Cosmetic and Spa Conference, Las patient satisfaction. Content includes Skin Care Specialists, Mandalay Bay Vegas Convention Center, Las Vegas. printable handouts, videos, interactive Resort & Casino, Las Vegas. Contact: Contact: 203.736.1699, iecsc.com learning guides and patient support tools 562.799.0466, spsscs.org July 26-27 Face and Body Midwest that can be customized by physicians April 23-27 The Aesthetic Meeting Spa Expo & Conference, Donald to refl ect their subspecialty and unique 2020, Mandalay Bay Resort and Casino, E. Stephens Convention Center, approach to care. Las Vegas. 562.799.2346, surgery.org Rosemont, IL. Contact: 630.653.2155, The Patient Care Toolkit can be April 29-May 2 American Society for faceandbody.com delivered to patients via a mobile app or Laser Medicine and Surgery (ASLMS) August 13-16 AAD Innovation displayed on the doctor’s own website. Annual Meeting, Phoenix Convention Summit, Washington State Convention “Physicians recognize the importance of Center, Phoenix. Contact: 877.258.6028, Center, Seattle, Washington. Contact: reaching their patients online, but fi nd it aslms.org 866.503.7546, aad.org

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SKIN CARE GETS PERSONAL

Nonsurgical Options For the Aging Neck

Sachin Shridharani, MD On Standing Out in a Crowded Field

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62 MARCH 2020 | MedEsthetics YEARS ASLMS 2020 PHOENIX ASLMS Annual Conference on ENERGY-BASED MEDICINE & SCIENCE April 29-May 3, 2020

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The American Society for Laser Medicine and Surgery, Inc. is the largest multi-disciplinary professional organization dedicated to the development and application of lasers and related technology for health care applications. The American Society for Laser Medicine and Surgery (ASLMS) is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. NEWSMAKERS | By Inga Hansen

HAIRMETRIX Canﬁ eld is introducing an innovative, AI-driven hair analysis and consultation system for aesthetic practitioners.

Hair loss and thinning hair affect the majority of men of results,” says Esposito. “For male clients, you take and women as they age. In the past few years, demand images in the temporal, vertex and occipital regions, the for hair restoration procedures has grown as new, images are automatically uploaded to and processed more effective treatments come to market. To help in our AI servers in the cloud and immediately returned practitioners and patients track progress, Canfi eld with the completed analysis.” Scientifi c—maker of the Visia Skin Analysis system—has Providers use Canfi eld’s VISIOMED D200evo developed HairMetrix, an artifi cial intelligence (AI)-driven, dermatoscope to take images of the scalp, and the noninvasive consultation tool. HairMetrix software analyzes the images and saves the data for follow-up comparison. In addition to capturing trichoscopy images, HairMetrix can capture global images using Canfi eld’s optional Mirror mobile iPad application, which also now includes ALODEX, a clinically validated hair density assessment for quantifying the extent of hair loss. “This complete hair consultation solution offers easy-to-read print reports, has a compare function for follow-up imaging, “The two key breakthroughs of HairMetrix are and the images and analytics are saved for future eliminating the need to clip the hair to acquire accurate appointments,” says Esposito. “It is easy to operate for information and an immediate analysis to provide a more users and easy for clients to understand, like the VISIA effective consultation,” says Sam Esposito, product Skin Analysis consultation, but now for hair loss analysis manager at Canfi eld Scientifi c. The system automatically versus skin analysis.” measures all the key hair indicators and metrics, such as Canfi eld has been trialing the system since October total non-vellus hair count, number of follicular units and 2019 with hair restoration specialists and key opinion terminal-to-vellus hair ratios, using similar analysis tools leaders and will launch HairMetrix at the American created and validated by Canfi eld Scientifi c for clinical Academy of Dermatology meeting this month. “The early research studies. users are excited about their HairMetrix experience and “This provides the practitioner an effective way we look forward to the broader launch,” said Esposito. to clearly communicate the treatment options while increasing compliance by providing objective evidence Inga Hansen is the executive editor of MedEsthetics.

64 MARCH 2020 | MedEsthetics guru.

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